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1 病历介绍 患者,男,30岁,1989年因皮肤出血点至医院就诊.发现脾肿大,乙型肝炎血清学指标HBsAg,抗-HBC,HBeAg阳性.诊断肝硬化,巨脾,脾功能亢进.1990年行脾切除及分流术,1992年突然消化道大出血,急诊诊断胃穿孔行修补术,此后间歇性出现性格暴躁,上肢及下颌震颤.一过性失明,大小便有时失禁,狂躁与昏睡交替,发作后对自己行为不能完全回忆,1993年春消化道再次出血,且反复出现上二述神经精神症状而住院治疗。入院后检查:神志清楚,计数力定向力正常、朴翼样震颤阳性,有时尿失禁或尿潴留,性格暴躁或忧抑,恐膜轻度黄染.肝掌阳性,腹平饮,肝肋下剑下未及,腹部无转移性浊音。实验室检查:血常规血小板正常范围,肝功能:血清总胆红素17.1～27.7umol/L.S-GPT<40u,血清总蛋白58.2g/L.白蛋白33g/L.球蛋白25.5g/L,凝血酶原时间28秒,血氨70umol/L,EKG大致正常,乙型肝炎HBsAg.抗-HBc,HBeAg三项阳性,按肝-脑综合
1 medical records of patients, male, 30 years old, due to skin bleeding to the hospital in 1989. Found that splenomegaly, hepatitis B serological indicators HBsAg, anti-HBC, HBeAg positive diagnosis of cirrhosis, splenomegaly, hypersplenism 1990 splenectomy and shunt surgery, sudden gastrointestinal bleeding in 1992, emergency diagnosis of gastric perforation line repair, then intermittent personality tragedy, upper extremity and jaw tremor .One blindness, sometimes incontinence, manic and lethargy Alternate, after the attack on their own behavior can not be completely recalled, the spring of 1993 digestive tract bleeding again, and repeatedly appear on the second neuropsychiatric symptoms and hospitalization. Post-admission examination: Consciousness, counting force orientation normal, Park-like tremor-positive, sometimes urinary incontinence or urinary retention, irritability or anxiety, fear of mild yellow dye. Not under the sword, the abdomen without metastatic dullness. Laboratory tests: normal range of blood platelets, liver function: serum total bilirubin 17.1 ~ 27.7umol / LS-GPT <40u, serum total protein 58.2g / L. Albumin 33g / L. Globulin 25.5g / L, Prothrombin time 28 seconds, blood ammonia 70umol / L, EKG roughly normal, hepatitis B HBsAg. Anti-HBc, HBeAg three positive, according to the liver - brain syndrome